MHA Today | November 22, 2019

November 22, 2019

November 22, 2019

MHA Today is provided as a service to members of the Missouri Hospital Association. Additional information is available online at MHAnet.

Insights

The Centers for Medicare & Medicaid Services released its final rule on price transparency late last week, with an effective date of Jan. 1, 2021. The rule requires approximately 6,000 hospitals to post in machine-readable format five types of “standard charges,” including gross charges, self-pay discounts, payer-specific negotiated charges, and minimum and maximum negotiated charges for all items and services. The rule also requires “consumer-friendly” posting of this data for 300 “shoppable services,” 70 of which are defined by CMS.

Earlier this month, the American Hospital Association joined with several other hospital and health care organizations to announce their intent to challenge the rule in court.

CMS’ position is that the lack of publicly available data on hospital and health care prices has stunted the move toward consumerism, which in turn has reduced the ability of consumers and payers to control costs in the system. However, despite the significant new requirements for hospitals, the rule precedes a new proposed rule that could help patients with “price shopping” — information on patient out-of-pocket cost.

History can be a powerful tool in understanding the potential influence of policy change. I happen to have some history on this issue from my time at CMS.

While I was serving as deputy administrator, a set of focus groups for physician utilization and performance transparency was launched. As data became available, participants had a much better understanding of their place relative to their peers. The expectation was that these metrics could help identify outliers and lead to practice modification. That’s what happened. Unfortunately, it didn’t happen in the way we expected or intended. Physicians looked at peers with high utilization rates and, rather than look at them as outliers, began discussing ways to model their behavior. The Advisory Board recently affirmed the possibility of this outcome.

Similar to what happened with the focus groups, there’s a very good chance that full disclosure of negotiated rates will put downward pressure on hospital reimbursement. The floor easily could become the ceiling for commercial rates, because hospitals’ and insurers’ incentives aren’t aligned across the entire patient population.

Missouri is ahead of the game on transparency and has been for more than a decade. The Focus on Hospitals website provides consumer-friendly data on price, quality and community investment — a much better picture of value. Missouri law requires that patients who request an estimate of their out-of-pocket costs receive one in a timely fashion. And, MHA at one time — long before price transparency was part of the health care sector’s zeitgeist — offered a nearly never-used “treatment cost estimator” tool online.

Better information on price, like most other aspects of health care, is most successful when it is focused on the patient and not the health care system. Anyone who has ever reviewed an explanation of benefits knows that what matters is not what the insurer paid for the service, but the balance due at the bottom of the page listed, “patient responsibility.” As the “consumer age” in health care expands, information on patient responsibility will become more important.

Hospitals and other health care organizations will spend significant time and energy to implement the rule if it stands. Those dollars will increase health care costs as they are shifted to payers, including patients. Some small hospitals already are signaling that the cost of compliance alone will put additional downward pressure on their bottom line. However, the truly pernicious aspects of this transparency effort could materialize when the race to the bottom begins among the payer community.

How this rule translates to responsible and informed consumer shopping is dubious. CMS should refocus their transparency work on information that is valuable to consumers. This rule has great potential to do more harm than good.

Congress Delays Government Shutdown And Medicaid DSH Cuts

As expected, Congress enacted legislation to delay a government shutdown while it works to develop an updated budget for the remainder of the federal fiscal year. The enacted bill extends budgetary authority through Friday, Dec. 20. Without action, that authority would have expired Friday, Nov. 22. The legislation also postpones a lapse in funding for various health-related programs and delays reductions in states’ allotments of federal funding of Medicaid Disproportionate Share Hospital payments.

MHA Comments On Hospital Broadband Needs

MHA wrote the Missouri Department of Economic Development regarding initiatives to expand access to broadband coverage throughout the state. The letter highlights hospitals’ need for higher-speed connections to handle their high-demand uses.

U.S. House Advances Legislation On Workplace Violence

The U.S. House of Representatives approved legislation directing the federal Occupational Safety and Health Administration to require hospitals and other health care employers to develop and implement plans to address workplace violence. The legislation is modeled on California state law. It moves to the Senate, where a companion measure has not advanced. An administration statement of policy opposes the proposal.

MHTTC Presents Webinar On Farm Stress

The Mountain Plains Mental Health Technology Transfer Center is hosting a free webinar series on stress associated with farming. The first webinar will be held on Monday, Nov. 25, and will focus on defining farm stress, the impact of stress on families, and how farming demographics and associated stress may vary by U.S. region. MHTTC also will inform participants of resources specific to the agricultural community.

MLN Connects Provider eNews Available

Updates to MLN Connects Provider eNews were issued by the Centers for Medicare & Medicaid Services. eNews includes information about national provider calls, meetings, events, announcements and other MLN educational product updates. The latest issue provides updates and summaries of the following.

CDC Releases Updated Vaping Lung Injury Report

The Centers for Disease Control and Prevention updated the vaping lung injury and death report. As many are aware, there recently was a second vaping-related death in Missouri. In addition to close partnership and leadership with the Clear the Air Campaign, the Missouri Department of Health and Senior Services developed a lung injury outbreak website. The site features useful information regarding the dangers of vaping use and how one can protect themselves, along with information targeted at health care providers.

AMA Calls For Complete Ban On Vaping Products

The American Medical Association has called for a total ban on all e-cigarette and vaping devices and products. Previously, they called for a ban on all flavored vaping products, and now are advocating for state and federal policy reform. In light of the recent surge in youth vaping, AMA seeks to keep the products and devices out of the hands of youth. The full article denotes a few specific criticisms of such a sweeping policy proposal, and notes that e-cigarette and vaping products have not been reviewed for FDA approval as a cessation assistance product.

Consider This ...

From 2016 to 2018, the number of uninsured children nationwide increased by 400,000 between 2016 and 2018, with more than 4 million lacking coverage. In Missouri, the number jumped from 71,000 to 83,000, a 17% increase.